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Nutcracker syndrome (a Delphi consensus).

Floor Heilijgers¹, Peter Gloviczki², Gerry O'Sullivan³

¹Department of Vascular Surgery, Leiden University Medical Center, Leiden, the Netherlands.

Journal of Vascular Surgery. Venous and Lymphatic Disorders

|October 3, 2024

Summary

This summary is machine-generated.

Nutcracker syndrome (NCS) involves left renal vein compression. This Delphi consensus provides expert agreement on NCS diagnosis and management, highlighting areas needing further research for this rare condition.

Keywords:

EVS Renal Autotransplantation LRV LRV transposition Endovascular Stenting NCS Delphi consensus Left Renal Vein Nutcracker Syndrome

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Area of Science:

Vascular Surgery
Nephrology
Interventional Radiology

Background:

Nutcracker syndrome (NCS) is symptomatic compression of the left renal vein.
While often asymptomatic, NCS can cause various patient symptoms.
Current diagnostic criteria and interventions for NCS are not standardized.

Purpose of the Study:

To establish an international consensus on the diagnosis, management, and follow-up of Nutcracker syndrome.
To address the lack of specific diagnostic criteria and standardized treatment protocols for NCS.

Main Methods:

A three-stage modified Delphi consensus involving 20 international experts.
Development and voting on 37 statements regarding NCS diagnosis, management, and follow-up.
Iterative voting rounds to achieve consensus on diagnostic values and treatment approaches.

Main Results:

Consensus was reached on 24 of 37 initial statements (65%) and 5 of 10 in the second round.
Experts agreed on the necessity of imaging for NCS confirmation.
Left renal vein transposition was favored as the primary surgical treatment over percutaneous procedures due to stent migration risks.

Conclusions:

Consensus was achieved on key aspects of NCS assessment and management.
Further research is recommended for antiplatelet therapy, endovascular treatments, and renal autotransplantation.
Establishing a rare disease registry for NCS is crucial for improving patient outcome data.